MEDICARE: ANNETTE GRAHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1497345631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE GRAHAM

Provider Business Mailing Address
First Line	:	2907 NADAR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-6729
Country	:	US
Telephone Number	:	214-392-8298
Fax Number	:

Provider Business Practice Location Address
First Line	:	2907 NADAR
Second Line	:
City	:	GRAND PRAIRIE
State	:	TX
Zip	:	75054-6729
Country	:	US
Telephone Number	:	214-392-8298
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/21/2021
Last Update Date	:	01/21/2021

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Directions to “ ANNETTE GRAHAM ” Practice Location

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